Cyclophosphamide hypersensitivity in a leukemic child.

Although hypersensitivity reactions to chemotherapeutic drugs have rarely been reported, they may occur with any of these agents. A Mexican native 44-kg 13-year-old boy suffering from acute lymphoblastic leukemia (ALL) received chemotherapy for 7 years. Three years later, a recurrence of ALL was detected in his right testicle. The patient was scheduled to receive 12 weekly cycles of 50 mg/kg of cyclophosphamide (CPM) as a 1-hour intravenous infusion. The patient did not have any history of drug allergies or any other type of ADR. Immediately after the fourth cycle of CPM, the patient developed itchy, maculopapular rash, sweating, respiratory distress, and anxiety. According to the algorithm developed by Naranjo et al, the ADR was classified as probably secondary to CPM. Skin tests were negative to hypersensitivity to CPM, and a new cycle of CPM was administered. However, the patient developed a similar hypersensitivity reaction to CPM. After an analysis of the clinical course of the ADR and the need to continue the chemotherapeutic treatment with CPM, we decided to desensitize the patient to this drug. Total duration of the procedure was 5 hours and was performed on only 1 occasion. The program of 12 cycles of chemotherapy was successfully completed without any sign or symptom of hypersensitivity to CPM. In conclusion, we have reported a case of hypersensitivity to CPM who was successfully desensitized to CPM.

[Cyclosporin A in atopic dermatitis]. / Ciclosporina A en dermatitis atópica.

Atopic dermatitis is a chronic inflammatory skin disease, with inherited predisposition. It has typical morphology and distribution. Patients generally can be controlled with the use of moisturizers and topical steroids. In severe cases, it is recommended the use of alternative management. Cyclosporine is an immunosuppressor drug which inhibit the expression of T activated cells. Many open and placebo-controlled trials have been made evaluating its use, efficacy and security, in adults and children. The results suggest an initial dose of 5-6 mg/kg per day and reducing the amount according to response (load dose and maintenance dose) at long term in order to reach complete remission after withdrawal of treatment and limit adverse effects, like renal toxicity and hypertension. The immunological changes in AD patients treated with cyclosporine include eosinophil count reduction, besides lower levels of E-selectin, and soluble CD30 (known as disease markers), but overall, it corrects the imbalance between Th1 and Th2 response present in these kinds of diseases.